Table 2b.
Sociocultural Findings
| SOCIOCULTURAL DOMAIN | |
| Stigma | |
| • Societal stigma-confusing cancer symptoms with HIV symptoms | o Iyho, in most of the cases, they never think of cancer…cancer is the last disease that they think of. When you lose weight, lose hair, having symptoms that are associated with HIV but having cancer, they will never think of cancer.”-FGD 4, 6 |
| • Social discrimination | o “They are scary” [people who have cancer]-FGD 3 o “…we don’t have information, people don’t talk when they have it and you can’t see that they have it…you’ll never know what is going on, they live a normal life”-FGD 1; Some of them hide themselves, they are afraid, maybe rejection…they are scared of being rejected.” FGD 4 o “Let’s say that a person’s mentality, when someone says that they have breast cancer, to be honest, the first thing that comes to mind is death” … “That person is leaving…she’s kicking the bucket…yes”-FGD 4 |
| • Fear or catching the disease of partners/spouses. | o “…the man of the house will no longer want to touch me… he is scared that he will get cancer because now I am dying”-FGD 1 o “…will she not infect me as I am living with her… as she calls me to go help her, I come running to go help her, I don’t have gloves I don’t have anything, maybe this thing of hers will also get me”-FGD 3 o “They will change towards me, won’t treat me like they used to at first.”, “They will judge me.”-FGD 2 |
| • Self-stigmatization | o Even marriage, your person…yes, indeed it’s obvious that a woman’s body is her confidence, you see…so to your person, let’s say you’re going there in the bedroom, bedroom things there, you’re scared to undress, your 1 breast is not there, one is there.”-…. “Less woman” FGD 3, 4, 6 o “…you feel guilty that “I will wake up and die, I’m going to die.”, “When they tell me that it is possible for it to be treated, my conscience will be down, it will be better, and then I will still live, and I will also do my best to comfort myself that “I’m still going to live for my children”-FGD 2 o “It becomes mine; it is my secret that will eat me up because we believe that cancer kills.”-FGD 1 |
| • Institutional stigma: Employer and Health Care providers | o “…. they will fire me, I’m no longer going to work, they will look for another person” FGD 2 o “Why do you want us to check you, we gave you pills, you’ll come back another day” [upon requesting to be screened]-FGD 2… Yes, they chase you away and say, “go home”, “You’ll come back the day you know what you have” [after informing them that you self-detected a health symptom] FGD 2 o “When they haven’t closed, they are still inside but you will think for yourself…they say “iyho, you come at this time, who do you think will attend you?”-FGD 4 |
| Culture, religious beliefs, and fatalism | |
| • Cancer is caused by dirty blood. | o “Sometimes they say that it is dirty blood, that cyst is caused by blood that is dirty-means that your blood is now dirty, it has created an internal cyst and then you rot inside”-FGD 1, 3 |
| • Food poisoning | o “….. or it can come out as cancer at the hospital, but they might not know how to treat it” … “Meaning it can come from sejesong (sejesong means food poisoning)-FGD 2 |
| • Witchcraft | o You were bewitched, got cursed, muthi was used, so, meaning that it is spiritual…they think that it is spiritual because of, you’ve been bewitched.”-FGD 3,4 |
| • Church as source of healing but also resistance to Western medicine | o “Isn’t it as long as you have faith that “when I pray, I will heal” … you will pray and heal”, “But some churches don’t want that isn’t it… when you go to them, they don’t want these doctors’ things and what, they only want to pray for you”-FGD 3 o “When you believe that you will be healed, when you believe that “this sick should leave”, it will leave” FGD 2 o “And when I get inside the church, I meet the pastor, the pastor will pour water for me and put hands on me”-(FGD 2) |
| • Role of traditional healers for good and for harm | o Yes, some doctors may never see a thing called sejeso (poisoning) you know, so they will tell you to…”, “They are important because, even these people, like doctors, when they are stranded, they tell you to go to a traditional healer.” FGD 4 o “And the painful thing, they treat something they don’t know…isn’t it cancer has stages, has this and that…maybe you’re on the last stage, they give you strong things that will make you leave sooner”-FGD 2. “I would say that traditional healers, they heal something that they don’t know, that they only imagine how it is.”-FGD 3 o “Sometimes, challenge number 1, they tend to overdose, when they say they give you mbiza, you find that they give you this much, you drink a lot, it doesn’t have grams, doesn’t have what…you just drink, 1 litre, you end up overdosing, you burden your body with the overdose of the mbiza that you were given”-FGD 3 o “isn’t it sometimes you find that you’re admitted at the hospital, and then, you find that they bring you stuff from home, the hospital says “no, these things are not allowed in.”-FGD 4, 6 |
| Health Literacy | |
| • Contrasting opinions on cancer information available to communities | o “Like television, even radio stations, they tend to call an expert to explain, even Google, you can get information”-FGD 2 o Sometimes when we’ve gone to the clinic, there are awareness’ [talks]”-FGD 3 o “Look right now we have Covid, they talk about it…HIV, about Aids, but cancer, there’s less awareness with it…you know, because yes, we hear that there’s a lot of them, but we are not even having ideas about the symptoms thereof, how it should be treated…like, things like that…like, we are clueless”-FGD 5 |
| Perceived benefit of preventive action | |
| • Early detection/diagnosis will lead to a longer survival rate | o “If they detect it early, it’s possible that they can remove the lump. And then, even when you go for treatments, you might find that, it can, through treatment-it can help you”-FGD 1 o “It hasn’t spread, it can be cured”-FGD 3 |
| Perceived barriers to preventive action | |
| • How it can be prevented is unknown; Preventive health seeking is not practised | o “…we don’t know how it can be prevented; I don’t have information on how it can be prevented…”-FGD 1, 6 o “I don’t know, especially with breast cancer”-FGD 2 o “We often relax”, “We don’t go to the doctor”-FGD 4 |
| • Only go to the clinic when they feel extreme pain | o “I don’t go anywhere if there’s no pain…I’ll keep saying “lump, I’ll see you some other time”, but when it starts being painful, that’s when I’ll jump and say “this thing is not making me sleep”-FGD 1, 2 |
| Economics | |
| • Being financially stable will enable a person to afford better healthcare services (private healthcare system), food and transport. | "Because remember that you need to eat specific food…you can’t eat foods that has fat, maybe it’s a diet that is strict, you need to eat certain foods, obviously if you don’t have money, it won’t be possible… I’m not able to get the things that I want and the food as mentioned earlier that “if I had money, I would be able to buy those pills when they say they can help”-FGD 2 o “Mam V maybe was able to get help because she went to like, private doctors, I just don’t know how if and how far public would help her because of our hospitals don’t ever have equipment”-FGD 5 o “…everything is expensive and then, these people, like, when you go to the privates, and cancer mostly is treated in the western way, you understand…and it’s as if the western way is what deals with it best, though we still drink our mixtures, so, people who have medical aids, obvious, you will go to landmet (Lancet laboratories) and go wherever…”-FGD 6 |
| • Money won’t save a person from dying from cancer. | o “Having money, no, it won’t help you”-FGD 3, 6 o “When it has eaten you, you go, you will leave that money behind.” FGD 3 |
| Social support structures | |
| • Individual (Self-acceptance to cope) | o “The first thing is to accept yourself, that is the first thing before you go out to the society, you have to accept and talk to yourself that “I have a sickness like this, I must accept it”-FGD 2 |
| • Family | o “…your friends and family ought to be with you through that thing that you’re facing because you might find that some families or some friends-they be with you just now, not throughout the whole process”, “you go to your family, family also counsels you, they guide you, things like that then, your friends also sit with you and comfort you while on your side…that’s how I think you can be okay”-FGD 2 |
| • Community (e.g., Church) | o “…with religion, obvious, they pray for you, you pray, you also have to have a believe…so, at churches, they pray for you according to you, like they pay for you, they will say “come, let’s pray, let’s pray for the sickness that you have to go down” at that time you also have faith that you will heal through prayers”-FGD 2 o “Prayer, you only use it when you’re going to do an operation that “Father God, please help the doctor so things can go well” …it’s how it will work”-FGD 3, 4, 6 |